Stiffened balloon catheter for dilatation and stenting

ABSTRACT

The present invention pertains to a stiffened balloon which can be used in angioplasty, endovascular, and valvuloplasty procedures or as a delivery balloon to deliver a stent or a stent-graft. Longitudinally discontinuous stiffening members connected to the expandable balloon stiffen the balloon but allow it to be navigated through curved passages. Projections on the stiffening members may engage, incise, crush, fracture, or pierce occlusions or retain a stent or stent-graft. Radio-opaque portions may be referenced to determine orientation. Longitudinally continuous stiffening members bearing projections and connected to the balloon perform in a similar manner.

This application claims the benefit of U.S. Provisional Application No.60/220,297, filed Jul. 24, 2000.

FIELD OF THE INVENTION

The invention relates to the field of balloon catheters for angioplastyand the delivery of stents and stent-grafts.

BACKGROUND OF THE INVENTION

Inflatable balloons are employed to dilate stenotic arteries inangioplasty, i.e., percutaneous transluminal coronary angioplasty(PTCA), to dilate stenotic cardiac valves in valvuloplasty, and todeliver and reconfigure stents and stent-grafts. To prevent late lumenloss and restenosis, a stent is carried on a balloon, positioned andexpanded to remain in a dilated vessel. Unfortunately, currentlyavailable balloon systems for angioplasty and for delivery and expansionof stents often fail to properly deploy the stent to produce a uniformdiameter and cross-sectional area along the length of the stent. Thisresults from the very nature of such a cylindrical balloon which is madeof a thin, flexible membrane and hence can expand radially to differentdiameters along its longitudinal dimension. If an obstructive lesion ina blood vessel is of a firmer and less compliant tissue than the normalvascular wall, e.g., fibrous or calcified matter, such tissue presents amuch greater resistance than the normal vascular wall to dilatation asthe balloon expands. As a balloon is expanded, such stenoses,narrowings, and obstructions impinge upon the expanding balloon to causean area of relative narrowing or distortion, a so-called “waist”.Correspondingly, a stent delivered on such a balloon will suffer from asimilar distortion or “waist configuration” as it is conformablyexpanded with the expanding delivery balloon.

If the stent adopts a “waist configuration”, it is generally indicativeof inadequate dilatation of the stenotic lesion within the blood vessel.The conventional approach to attempt to remedy this inadequacy has beento increase pressure within the balloon to expand the narrowed area. Attimes, a separate, higher pressure balloon is utilized. To produce suchhigher pressure balloons, flexible balloon membranes, which couldrupture under increasing internal pressure, were replaced by more rigidballoon materials that permitted much higher internal pressures.However, the more rigid material still has an elastic limit. Balloonsmade of such material and excessively inflated will be permanentlydeformed, and may eventually burst. Such deformed balloons are much moredifficult to remove from the patient. Moreover, increasing the pressurein the balloon increases the potential for rupture and serious harm tothe patient.

Even the use of higher pressures permitted by more rigid balloons areinsufficient to dilate some arterial stenoses, particularly if they havean annular configuration. With the stent not completely open and thelumen not fully dilated, the final therapeutic result is less thanoptimum. Some residual stenoses and a non-uniform cross-sectional areaalong the length of the stent will result.

Another problem frequently encountered during balloon dilation of stentsis the occurrence of flaring of the stent at its ends. Stents aregenerally manufactured as an independent cylindrical structure orintegrated in a sleeve that is slipped onto the balloon and adhered.Conventionally, the balloons are at least slightly longer than thestents that they carry.

As the balloon is inflated and it expands the stent, it typically meetsless resistance at the ends of the stent and outside the confines of thestent than it does within the stent. Hence, at full inflation theballoon has a tendency to expand to a slightly larger diameter beyondthe ends of the cylindrical stent than at the middle of the stent. Theresulting different diameters of expansion are transferred to the stentcausing a “trumpet-like” outward flaring of the stent at its ends, whichis undesirable.

Additionally, there are several problems with the conventionalmethodology for delivering a stent to an occlusive site with aconventional balloon catheter. In trying to force the stent inside atight occlusion, calcified matter or other irregularity at the occlusionoften provides resistance against the leading edge of the ballooncatheter and may resist entry and positioning of the stent. As theoperator tries to advance or withdraw the catheter, the calcified matteror other irregularity may catch hold of the stent and capture it inplace while the catheter is moved, causing the stent to separate fromthe balloon. If the stent is displaced with respect to the balloon,slips partially off the balloon, or separates from the balloon entirely,then the stent will not deploy properly. If the undeployed stentseparates from the balloon entirely, retrieving the undeployed stentbecomes a very serious problem. Similarly, a stent that is onlypartially deployed or is incorrectly positioned presents a verysignificant risk to the patient.

Where an occlusive site is only partially accessible by means of aconventional balloon catheter, i.e., only one end of an occlusion has aninner diameter that is of sufficient size to receive a balloon catheter,expansion of the balloon often causes the entire device to be squeezedand slip out of the occlusive site entirely. Thus, attempts to open suchpartially accessible occlusive sites often fail. To keep the prior artdevice within the occlusive site a great deal of force may need to beapplied by the operator to prevent the device from slipping out. Suchforce causes additional stress at the occlusive site and in surroundingstructures which present a further risk of rupturing the target site orcausing damage to the surrounding areas. This same behavior is alsoobserved in situations where an occlusion is irregular in diameter andthe expanded balloon simply slips out of the occlusive site uponreaching a particular state of expansion.

The same difficulties are encountered in attempting to position anddeploy a stent-graft with a conventional balloon catheter. Incompletestent-graft deployment can result in troublesome endoleaks caused byinadequate or otherwise ineffective sealing of the stent-graft at theends with the interior of the vessel. Such endoleaks allow a channel ofblood flow to develop that bypasses the stent-graft, greatly reducingits effectiveness and potentially causing the stent-graft to migrate.Where stent-grafts are deployed to exclude aneurysms, such as in theendovascular repair of an abdominal aortic aneurysm, endoleaks are avery significant problem in that they may allow flow to an aneurysm thatcould cause the aneurysm to rupture.

U.S. Pat. No. 4,796,629, by one of the present inventors, describes astiffened dilation balloon which addresses some of these problems byproviding an expandable balloon which exerts greater expansion force onlocalized regions within the lumen. It has been found that the uniformexpansion provided by the balloon catheter device described in U.S. Pat.No. 4,796,629 achieves superior results in dilating occluded vessels. Assuch a stiffened dilation balloon is expanded within an occlusion, thelongitudinal stiffener, acting as a rigid beam, transmits expansionforce applied to the entire length of the stiffener by the balloon tothe localized points of resistance in the vessel. Thus, as compared to aconventional balloon, the force of dilation applied locally isconsiderably increased and dilatation of highly resistant lesions isgreatly facilitated. Such a stiffened dilation balloon is capable ofachieving the same degree of dilatation as a standard balloon deliverysystem but at lower pressures. The stiffeners significantly increase therigidity of the balloon, reducing variations in the cross-sectional areaof the balloon along its length and reducing the occurrence of annularregions with a narrowed waist.

Additionally, it has also been found that an inherent limitation of theballoon catheter device described in U.S. Pat. No. 4,796,629 is itslimited maneuverability for deployment in the vascular system. Thestiffeners of such a device are fairly rigid, have a fixed length inexcess of the turning radius needed to navigate certain pathways andhave a fixed, although not necessarily uniform, cross-section. As aresult, it can be particularly difficult to navigate the device of U.S.Pat. No. 4,796,629 through the vascular system to reach certainocclusions in smaller vessels without utilizing non-standard entrylocations or invasive manual procedures for straightening tortuousvascular pathways.

SUMMARY OF THE INVENTION

The present invention is directed to an improved balloon catheter havingan expandable balloon with stiffening members that aid in uniformexpansion of the balloon at a target site in a lumen in the human body.The balloon catheter can be used in angioplasty, endovascular, orvalvuloplasty procedures, or for the delivery and/or reconfiguration ofstents or stent-grafts. The invention is also directed to methods ofdilating or expanding a lumen in the body using a balloon catheter.Further, methods for delivering a stent or stent-graft to a lumen in thebody using the balloon catheter are provided. In addition, methods forreconfiguring and repositioning improperly deployed stents andstent-grafts are disclosed. It should be understood that use of the term“balloon” in describing the invention encompasses any balloon, chamberor other structure which can be inflated or deflated or otherwiseexpanded or reduced in size. It should also be understood that use ofthe term “lumen” in describing the invention encompasses any vessel,fluid path, valve, other flow passage or the like, or the interiorvolume of any of these.

The balloon catheter of the present invention comprises a catheterhaving a flow passage for pressurized fluid with an expandable chamber,such as a balloon, connected in-between distal and proximal cathetersections. The expandable chamber is generally bounded by a wall suitablyconfigured for containing a pressurized fluid. A plurality of stiffeningmembers are peripherally disposed along the expandable chamber. Suchstiffening members may be embedded in the wall or connected to the inneror outer surface of the wall. The stiffening members generally move withthe wall of the expandable chamber and are configured to resistlocalized deformation in the wall of the expandable chamber.

The stiffening members may be provided with one or more projections thatculminate in either a pointed or blunt apex. The projections mayfunction to retain a stent or stent-graft when the chamber is in anunexpanded state, may engage a lumen, and may engage, incise or piercean occlusion when the chamber is expanded. The stiffening members andthe projections may be made radio-opaque so that the balloon or thestent may be precisely located by x-ray imaging.

A stiffening member at the wall of the balloon may be provided withdiscrete points integral with or connected to the surface of thestiffening member. The points may be configured or positioned to remainenveloped within pleats of the unexpanded balloon or retained below thesurface of a stent until the balloon is expanded.

A stiffening member at the wall of the balloon may be provided withstent retention structure integral with or connected to the stiffeningmember. The stent retention structure may include at least oneprojection on at least one stiffening member.

The stiffening members may be longitudinally continuous ordiscontinuous, and may include many individual stiffening elements. Thestiffening elements may have a uniform shape, include elements havingdifferent shapes, or occur as an array of discrete elements which areadhered or otherwise attached to the expandable chamber. The stiffeningmembers, as well as the individual elements, may act independently orcooperate to form one or more larger structures. Multiple stiffeningelements may co-act via one or more attaching elements (e.g., afilament) between individual elements.

Accordingly, it is an object of the invention to further overcome theproblems and deficiencies of the prior art.

In particular, it is an object of the invention to provide an improvedstiffened balloon for dilatation and stenting, stent retention, vesselengagement and piercing, balloon orientation and balloonmaneuverability.

It is an object of the invention to provide a stiffened balloon withgreater maneuverability than that of the prior art.

It is another object of the invention to provide improved stiffeningmembers for balloons for angioplasty, valvuloplasty, stent delivery andstent-graft delivery or reconfiguration.

It is another object of the invention to provide improved stiffeningmembers for balloons to engage a lumen and to engage and fractureocclusive material within a lumen.

It is a further object of the invention to provide improved stiffeningmembers for balloons to retain a stent or stent-graft for delivery to orrepositioning at a target site in a lumen and for reconfiguring apartially deployed stent or stent-graft.

It is still another object of the invention to provide a stent deliverysystem for use in angioplasty procedures which achieves full dilation ofa stenosis and complete deployment of a stent or stent-graft at the siteof an obstructive lesion.

According to an aspect of the invention, a stiffened dilating balloonincludes an expandable balloon that includes a plurality oflongitudinally discontinuous stiffening members disposed along aperimeter of the balloon; the balloon is made of a flexible material;the stiffening members are less flexible than the balloon; and eachstiffening member affects a configuration of an area of the perimeter ofthe balloon.

According to another aspect of the invention, a stiffened balloonincludes an expandable balloon that includes a plurality oflongitudinally continuous stiffening members disposed along a perimeterof the balloon; the balloon is made of a flexible material; thestiffening members are less flexible than the balloon; each stiffeningmember affects a configuration of an area of the perimeter of theballoon; and at least one of the stiffening members includes aprojection adapted to temporarily retain a device at the balloon.

According to another aspect of the invention, a stiffened balloonincludes an expandable balloon including a plurality of longitudinallycontinuous stiffening members disposed along a perimeter of the balloon;the balloon is made of a flexible material; the stiffening members areless flexible than the balloon; each stiffening member affects aconfiguration of an area of the perimeter of the balloon; and at leastone of the stiffening members includes a raised surface.

According to a further aspect of the invention, a method of using astiffened balloon to dilate a lumen and deploy an expandable deviceincludes the steps of: introducing into a lumen a stiffened balloonbearing an expandable device; expanding the balloon and the device tocause at least one projection on a stiffener of the balloon to protrudeabove an outer surface of the stent and engage an inner surface of thelumen; dilating the lumen; and deploying the device in the lumen.

According to a still further aspect of the invention, a method of usinga stiffened balloon to dilate a lumen and deploy an expandable deviceincludes the steps of: interdigitating at least one projection on astiffener of a stiffened balloon with an expandable device; introducinginto a lumen the stiffened balloon bearing the device; expanding theballoon and the device; dilating the lumen; and deploying the device inthe lumen.

According to another aspect of the invention, a stiffened balloonincludes an expandable balloon including a plurality of longitudinallycontinuous stiffening members disposed along a perimeter of the balloon;the balloon is made of a flexible material; the stiffening members areless flexible than the balloon; each stiffening member affects aconfiguration of an area of the perimeter of the balloon; and at leastone of the stiffening members includes a pivot point where thestiffening member may be bent to facilitate navigation of the balloonthrough a passage.

According to a further aspect of the invention, a method ofreconfiguring a portion of an expandable device deployed at a lumenincludes the steps of: introducing into the lumen a stiffened balloonbearing a longitudinal stiffener at a first location on the balloon;aligning the longitudinal stiffener with the portion of the expandabledevice; and expanding the balloon to cause the stiffener to exert afirst radial force against the portion of the expandable device toreconfigure that portion; and the first radial force is greater than aradial force applied by said balloon at any other location on theballoon.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a diagram of a closed-ended balloon with discontinuousstiffening members;

FIG. 2 is a diagram of an open-ended balloon with continuouslongitudinal stiffening members having projections;

FIG. 3 is a diagram of a closed-ended balloon with continuouslongitudinal stiffening members having projections and a stentpositioned on the balloon;

FIG. 4 is a diagram of a stent-graft;

FIGS. 5A, 5B, 5C and 5D are diagrams showing cross-sectional views ofballoons with projections;

FIGS. 6A, 6B and 6C are diagrams showing stiffening members with areasof increased flexibility;

FIGS. 7A-7G are diagrams showing discontinuous stiffening members;

FIGS. 8A-8I are diagrams showing cross-sectional views of stiffeningmembers;

FIGS. 9A-9J are diagrams showing stiffening members;

FIGS. 10A-10G are diagrams showing projections; and

FIG. 11 is a diagram showing interconnected projections.

DETAILED DESCRIPTION OF THE INVENTION

FIG. 1 is a drawing of an embodiment of the present invention, indicatedgenerally as device 10, particularly suited for navigating curved orotherwise angled passages. In angio-valvuloplasty procedures, device 10may be advantageously utilized to access vessels via passages that havecurved sections and, in certain embodiments, even passages that includeacute angles. Device 10 comprises a balloon having a distal end 12, aballoon 14, discontinuous stiffening members 16 and proximal end 18.Device 10 is generally comprised of standard inert balloon cathetermaterials suitable for introduction into the human body.

Distal end 12, balloon 14 and proximal end 18 are preferably comprisedof a thin, flexible, and generally inelastic material that expandsoutwardly to assume a predetermined shape at a particular interiorpressure, e.g., an envelope with a fixed configuration. Alternatively,end 12, balloon 14 and end 18 are formed from an elastic material. Whileend 12, balloon 14 and end 18 may be discrete components attachedtogether and have different expansion characteristics, it is preferablethat a single contiguous piece of material be used to construct allthree.

Distal end 12 defines a volume contiguous with that volume defined byballoon 14. Distal end 12 is shown tapered and closed so that it may beused as a probe for threading device 10 through a lumen. Alternatively,distal end 12 may be arcuate and may have a channel formed in it for theplacement of a guide wire on which device 10 could travel. As a furtheralternative, distal end 12 may be open-ended, e.g., as shown at 42 inFIG. 2.

Balloon 14 comprises a generally cylindrical balloon (as previouslydefined) which defines a generally cylindrical volume, has a relativelyuniform and continuous surface. Preferably, balloon 14 and distal end 12are formed without seams therebetween and do not leak. Alternatively,balloon 14 may comprise a chamber independent from distal end 12, e.g.,without fluidic connection.

Proximal end 18 defines a volume contiguous with that volume defined byballoon 14 and is shown tapered. Preferably, proximal end 18 is open toprovide a flow path for fluid to be flowed into balloon 14. Balloon 14includes a plurality of discontinuous stiffening members 16, preferablyaligned along balloon 14 in separate longitudinal rows of stiffeningmembers arranged radially around the perimeter of balloon 14.

The individual stiffening members 16 are preferably made of a uniformmaterial but may be made of different materials. Preferably, individualstiffening members 16 are formed from a flexible metal, plastic or fibermaterial; a composite material; or the like. Such materials arepreferably inert and compatible with usage in the human body. Stiffeningmembers 16 may be smooth or roughened. In an alternative embodiment,stiffening members 16 may be made of the same materials of which theballoon is made. Alternatively, a compatible material that is more rigidthan the material of balloon 14 may be used. As a further alternative, amaterial or composite that is flexible in one direction but rigid inanother may be utilized.

The rigidity and flexibility of stiffening members 16 is preferablymatched for a desired purpose utilizing the various embodiments ofstiffener configurations described herein. Longer and more rigidstiffeners may be advantageously utilized to dilate tougher occlusivematerial. Shorter and more flexible stiffeners may be advantageouslyutilized to more easily navigate through contorted passages. Stiffeningmembers 16 may be more rigid than a stent or stent-graft that theycarry.

Stiffening members 16 may be attached to balloon 14 by conventionaladhesive, constructed as part of the material of balloon 14, patternedas layers upon balloon 14 or embedded in balloon 14. Alternatively,stiffening members 16 may be constructed as part of a sleeve or sheaththat is fit over balloon 14 or as part of a sheet that is wrapped aroundballoon 14.

Device 10 may be attached to a separate catheter apparatus (not shown)or integrated therewith. For example, to attach device 10 to such acatheter directly, proximal end 18 or distal end 12 may be tapered toform a cylindrical section approximately the cross-sectional size of thecatheter and bonded to the catheter with a bonding agent or an adhesive,or by ultrasonic welding or the like. Alternatively, device 10 may befolded within a catheter and carried therein.

In operation, device 10 is navigated through passages to a target lumen.The discontinuities in stiffening members 16 and the flexibility ofballoon 14 allow device 10 to pass through curved passages by bendingdevice 10 at the discontinuities. Upon reaching the target lumen, afluid is flowed through proximal end 18 into balloon 14 and distal end12 to expand balloon 14. Balloon 14 expands radially and stiffeningmembers 16 contact the inner surface of the target lumen. Stiffeningmembers 16 act to focus the expansion force of balloon 14 at theocclusions in the lumen contacted by members 16. As the interiorpressure of balloon 14 is increased, members 16 engage, cut, pierce orcrush the occlusions, facilitating dilatation of the target lumen by theexpanding balloon 14.

Another embodiment of the invention, specifically adapted for engagingor piercing occlusions in a lumen is shown in FIG. 2. In FIG. 2, adevice 40 comprises a distal end 42, a balloon 44, longitudinalstiffening members 46, and a proximal end 50. A catheter 54 is alsoshown.

Distal end 42 is the same as distal end 12 except that distal end 42 isopen ended. Distal end 42 is shown attached to catheter 54 at seal 41.Seal 41 may be formed with a bonding agent, an adhesive, as acompression seal, or by welding, or the like. As shown, seal 41 ispreferably formed by folding the material of distal end 42 inward oncatheter 54. Alternatively, seal 41 may be formed by any suitable priorart process for forming a seal between a balloon and a catheter.Preferably, seal 41 provides a fluid-tight seal.

Proximal end 50 is the same as proximal end 18 except that proximal end50 includes seal 52. Seal 52 may be created by the same processes usedto create seal 41. Seal 52 provides a seal between proximal end 50 andcatheter 54 and is preferably a fluid-tight seal.

Catheter 54 is a catheter for carrying and inflating balloon 44. Asshown, balloon 44 is sealed at seal 41 and seal 52 to catheter 54.Catheter 54 extends through the body of distal end 42, balloon 44, andproximal end 50 as generally indicated at 56. Catheter 54 includes flowholes 58 which provide a flow path for a pressurized liquid to flow fromcatheter 54 through to the interior volume of balloon 44. Such flowcauses balloon 44 to expand. Catheter 54 may carry a flexible guidewire(not shown) that extends through catheter 54 and is slidably adjustabletherethrough. Catheter 54 may include a dedicated longitudinal channelspecifically for carrying the guidewire.

Balloon 44 is the same as balloon 14 except that balloon 44 bearslongitudinally continuous stiffening members 46. One or more ofstiffening members 46 includes one or more projections 48. Projections48 may be attached to or integral with members 46. A plurality ofmembers 46 may be provided on, attached to, or embedded in balloon 44.Stiffening members 46 and projections 48 may be made of the samematerials as members 16 and each may be of a different material.Projections 48 may be smooth or roughened. Preferably, projections 48are 0.004 to 0.015 inches tall and may be shorter or taller, dependingupon the application.

As balloon 44 is expanded, members 46 focus radial expansion forces atprojections 48 and along the length of each respective member 46.Projections 48 contact occlusions within a lumen to engage, incise,pierce, fracture, or crush the occlusions or to engage an inner surfaceof the lumen. By engaging the inner surface of the lumen, projections 48prevent balloon 44 from slipping through a lumen as balloon 44 isexpanded.

In an alternate embodiment, balloon 44 is constructed as a closed-endedballoon, e.g., like balloon 14.

In a further embodiment of the invention, FIG. 3 shows a device 60 fordeploying a stent 70. Device 60 comprises a distal end 62, a balloon 64,and a proximal end 68. Distal end 62, balloon 64 and proximal end 68 arethe same as distal end 12, balloon 14 and proximal end 18, respectively,except that balloon 64 bears stiffening members 66. One or more ofstiffening members 66 includes one or more projections 72. Projections72 are specifically adapted for retaining stent 70 as it is beingpositioned or guiding stent 70 as it is expanded in a lumen or both.Members 66 and projections 72 may be made of the same material asmembers 16 and each may be of a different material. Members 66 andprojections 72 may be smooth or roughened.

Stent 70 is a conventional stent as known in the art. As shown, stent 70may include circumferentially expandable members 74 and longitudinallyexpandable members 76.

In a preferred operation, balloon 64 is expanded and the radial force ofexpansion is focused by members 66 on portions of stent 70, preferablymembers 74. Members 66, disposed at intervals along the perimeter ofballoon 64 facilitate uniform expansion and deployment of stent 70.Members 66 may match the stent in length or extend beyond the ends ofthe stent to minimize flaring of the ends of the stent. Projections 72act to prevent stent 70 from separating from (e.g., slipping off),balloon 64 as balloon 64 is expanded. Alternatively, if members 66 arespecifically placed at only selected locations on balloon 64, a custom,non-uniform expansion and deployment of stent 70 can be achieved.

Besides assisting in the expansion of stent 70, device 60 mayadditionally or alternatively assist in the positioning of stent 70during a deployment. Projections 72 may hold stent 70 in place onballoon 64 as the entire device is navigated through a passage andprecisely located.

As a further alternative, either or both projections 72 and members 66may be utilized to additionally engage, incise, pierce, fracture orcrush occlusions encountered in a lumen during or after deployment ofstent 70. Specifically, portions of projections 72 or members 66 mayextend radially beyond the surface of stent 70 and may extend throughstent 70. Optionally, either or both projections 72 and members 66 mayinterdigitate with complementary interface structure of stent 70. Asillustrated, projections 72 may interdigitate with one or more ofexpandable members 74 and 76.

The height of projections 72 preferably match the thickness of thedevice which is carried on the balloon. It is further preferred, whereengagement with the lumen is desired, that the height of projections 72exceeds the thickness of the device carried on the balloon and that suchheight be even greater where piercing of an occlusion is desired.

In an alternate preferred embodiment, each of projections 72 isconfigured as a post (see FIG. 10E) which fits within a complementaryslot located in stent 70. In general, each of projections 72 may beindividually designed to interlock or otherwise removably couple withcomplementary corresponding structure provided on an expandable device,such as stent 70.

FIG. 4 shows a conventional stent-graft 90 as known in the art. Asshown, stent-graft 90 includes expandable radial members 92 and mesh 94.Stent-graft 90 may be substituted with any conventional stent-graft. Inthe same manner that device 60 may be utilized to position, expand anddeploy stent 70, stent-graft 90 may be similarly positioned, expandedand deployed.

In each of devices 10, 40 and 60 the respective stiffening members maybe positioned on the outside of the balloon as shown in FIG. 5A, in theballoon material as shown in FIG. 5B, on the inside of the balloon asshown in FIG. 5C, or collected in a selected area as shown in FIG. 5D.

FIG. 5A shows a cross-sectional view of a device 100 comprising aballoon 102 according to the present invention having evenly-spacedexternal stiffening members 104. Also shown is a stiffening member 106having a radio-opaque portion 108. Portion 108 may be made radio-opaqueas described hereinbelow. FIG. 5B shows a cross-sectional view of adevice 110 comprising a balloon 112 according to the present inventionhaving embedded stiffening members 114. FIG. 5C shows a cross-sectionalview of a device 120 comprising a balloon 122 according to the presentinvention having internally-located stiffening members 124. FIG. 5Dshows a cross-sectional view of a device 130 comprising a balloon 132according to the present invention having members 134 and 136 located ina localized area on the perimeter of balloon 132. Members 134 and 136may have the same or different (as shown) cross-sections.

In an alternate embodiment, FIGS. 5A, 5B, 5C and 5D illustrate thepositioning of individual projections 104 and 106; 114; 124; and 134 and136, respectively, on a balloon.

FIGS. 6A, 6B and 6C show alternative configurations for stiffeningmembers according to the present invention. Each such configurationspecifically creates a portion of the stiffening member where it mayflex or pivot to facilitate navigation of the stiffening member througha curved passage. FIG. 6A shows a stiffening member 160 having alocalized narrow area 162 which facilitates the flexing or pivoting ofmember 160 at an area 162. FIG. 6B shows a stiffening member 170 havinga narrowed area 172 comprising cut-outs 174 and 176 which facilitate theflexing or pivoting of member 170 at an area 172. FIG. 6C shows astiffening member 180 having narrowed areas 182 and 183 created bytriangular cut outs 184 and 186, 188 and 190, respectively. Each ofnarrowed areas 182 and 183 is a point at which member 180 may flex orpivot.

FIGS. 7A-7G show alternative designs for stiffening members according tothe present invention. Each such alternative design providesdiscontinuous stiffening members that may be advantageously navigatedthrough curved passages. FIG. 7A shows members 200 comprising end pieces202 and interior pieces 204. Alternatively, one or more of pieces 202and pieces 204 may be omitted. FIG. 7B shows members 220 comprising endpieces 222, having projections 224, and interior pieces 226 havingprojections 228. FIG. 7C shows members 240 comprising end pieces 242 andinterior pieces 244. FIG. 7D shows members 260 comprising end pieces 262and “S”-shaped interior pieces 264. FIG. 7E shows members 280 comprising“L”-shaped pieces 282 and 284. FIG. 7F shows members 300 comprising endpieces 302 and interior pieces 304. It should be noted that the surfacearea of interior pieces 304 along the surface of the balloon is greaterthan the surface area of pieces 308. As a consequence, upon expandingthe balloon, pieces 306 will protrude above the upper surfaces of pieces308.

FIG. 7G shows members 320 comprising pieces 322 connected by filaments324. Filaments 324 are preferably flexible but inelastic to limit thevariation in positioning of members 320. Alternatively, filaments 324are elastic.

FIGS. 8A-I show cross-sectional views of numerous stiffening membersaccording to the present invention. In FIG. 8A, a capsule-shapedcross-section 350 is shown. In FIG. 8B, a capsule-shaped cross-section360 upon which a projection 362 is located is shown. In FIG. 8C, anarcuate cross-section 370 is shown. In FIG. 8D, an arcuate cross-section380 with projection 382 is shown. In FIG. 8E, a crescent-shapedcross-section 390 is shown. In FIG. 8F, a triangular cross-section 400is shown. In FIG. 8G, a rectilinear cross-section 410 is shown.Alternatively, it is contemplated that cross-section 410 may be modifiedby rounding its corners. In FIG. 8H, a circular cross-section 420 isshown. In FIG. 8I, an acute triangular cross-section 430 is shown.

FIGS. 9A-J show perspective views of alternative embodiments ofstiffening members according to the present invention. In FIG. 9A, adisc-shaped member 440 is shown. In FIG. 9B, an elliptical-shaped member450 is shown. In FIG. 9C, a triangular-shaped member 460 is shown. InFIG. 9D, a rectilinear-shaped member 470 is shown. In FIG. 9E, ahexagonal-shaped member 480 is shown. In FIG. 9F, a trapezoidal-shapedmember 490 is shown. In FIG. 9G, a sawtooth member 500 is shown. In FIG.9H, a “Z”-shaped member 510 is shown. In FIG. 9I, an “L”-shaped member520 is shown. In FIG. 9J a chair shaped member 530 is shown.

FIGS. 10A-G show alternate embodiments of projections according to thepresent invention. FIG. 10A shows a rounded projection 540. FIG. 10Bshows a conical projection 550. FIG. 10C shows a pointed projection 560.FIG. 10D shows a pyramidal projection 570. FIG. 10E shows a postprojection 580. FIG. 10F shows a “U”-shaped projection 590. FIG. 10Gshows a “C”-shaped projection 592. Projection 540 is particularlyadapted to crushing an occlusion. Projections 550, 560 and 570 areparticularly adapted to engaging and piercing an occlusion and may beutilized to hold a stent or stent-graft. Projection 580 is the preferredembodiment of a projection for interdigitating or otherwise interfacingwith a stent or stent-graft. Projection 590 provides a more complexstructure for interdigitating with complementary structure on a stent orstent-graft and may be used to couple to a specific transverselyoriented structural element of such a stent or stent-graft. Similarly,projection 592 may be utilized to hook or otherwise clamp a stent orstent-graft and may be particularly useful in exerting a pulling force.Projections 580, 590 and 592 may have blunt or pointed ends.

FIG. 11 illustrates a system 600 of interconnected projections.Projections 602 and 604 are connected by filaments 606. Filaments 606may be comprised of an inelastic material or alternatively may be formedfrom an elastic material. Preferably, filaments 606 limit the variationin the positioning of the projections relative to each other. In thismanner a network of projections may be interconnected to form a sheet,sheath or sleeve of projections that may be attached to a balloon.

Any of the stiffening members, projections or filaments described in theforegoing may be rendered opaque to x-rays or other radiation(collectively, “radio-opaque”) to facilitate determination of theposition of the balloon within a blood vessel and its position relativeto the target lumen. In addition, radially arranged radio-opaquestiffeners or projections may be referenced to determine the degree ofballoon expansion as a balloon is inflated. A single stiffening memberthat is radio-opaque along its length may be referenced to determine theaxial and radial orientation of the balloon, including the amount ofaxial rotation. The stiffening members, projections and filaments may bemade radio-opaque by conventional techniques, such as surface coating orprinting, incorporation of radio-opaque material into the substance ofthe stiffening member (e.g., barium or bismuth salts blended intopatterns) or construction of the stiffening member of a material withinherent radio-opacity, such as metallic tungsten.

A longitudinal stiffener with a longitudinally radio-opaque portion isadvantageously utilized to reconfigure an expandable device that isalready deployed within a lumen. Where such device has been deployed butrequires reconfiguration, the position of the radio-opaque portion ofthe stiffener may be referenced to determine the location of thestiffener and guide its alignment with the expandable device. If aportion of the device requires further expansion, a small number oflongitudinal stiffeners on a balloon may be aligned with the portion ofthe device requiring expansion to focus the radial force of expansion atthe particular portion of the device. In this manner, a stiffenedballoon with a longitudinal stiffener having a radio-opaque portion maybe utilized to specifically further expand an end of a stent-graft thathas not been properly deployed and has resulted in an endoleak.

For example, a balloon with a single radio-opaque longitudinal stiffenermay be rotated to align the stiffener with an unexpanded portion of thestent-graft and expanded. Upon expansion of the balloon, the stiffenerwill exert a focussed force against the unexpanded portion of thestent-graft while the remainder of the balloon will exert less force atall other positions on its surface. Accordingly, the unexpanded portionof the stent-graft will be further expanded but the remainder of thestent-graft will not be expanded at all or will be expanded much less.

Similarly, utilizing a suitable configuration of projections, astiffened balloon bearing a stiffening member having a projection may beutilized to push or pull a device expanded in a lumen to reposition it.Upon expansion of the balloon, the projection is oriented to fit acomplementary interface at the device. The projection and the interfaceare connected and the device is repositioned by changing the position ororientation of the stiffened balloon.

While preferred embodiments of the invention have been described withparticularity and with reference to the drawings, modifications andvariations of the foregoing will be apparent to those of skill in theart utilizing the techniques disclosed herein. It is, therefore, to beunderstood that such embodiments are illustrative and not limiting onthe scope of the present invention and that the invention encompassessuch modifications and variations.

1-45. (canceled)
 46. A method of reconfiguring a portion of anexpandable device deployed at a lumen comprising the steps of:introducing into the lumen a stiffened balloon bearing a longitudinalstiffener at a first location on the balloon; aligning said longitudinalstiffener with the portion of the expandable device; and expanding saidballoon to cause said stiffener to exert a first radial force againstthe portion of the expandable device to reconfigure the portion; whereinsaid first radial force is greater than a radial force applied by saidballoon at any other location on the balloon.
 47. The method of claim 46wherein said step of aligning comprises the steps of: determining anorientation of said longitudinal stiffener with reference to aradio-opaque portion of the stiffener; and modifying the orientation ofsaid longitudinal stiffener to align with the portion of the expandabledevice.
 48. The method of claim 47 wherein said step of determining anorientation comprises the step of determining a first rotationalorientation of said longitudinal stiffener with reference to saidradio-opaque portion.
 49. The method of claim 48 wherein said expandabledevice is a stent.
 50. The method of claim 48 wherein said expandabledevice is a stent-graft.
 51. The method of claim 48 wherein said step ofmodifying the orientation of said longitudinal stiffener comprises thestep of rotating the balloon around a longitudinal axis of the balloonto position said longitudinal stiffener at a second rotationalorientation within the lumen.
 52. The method of claim 51 wherein saidstep of aligning further comprises the step of determining said secondrotational orientation with reference to said radio-opaque portion. 53.The method of claim 47 wherein said step of modifying the orientation ofsaid longitudinal stiffener comprises the step of translating theballoon longitudinally within the lumen.
 54. The method of claim 47wherein said step of determining an orientation comprises the step ofdetermining a longitudinal orientation of said longitudinal stiffenerwith reference to said radio-opaque portion.
 55. The method of claim 54wherein said step of modifying the orientation further comprises thestep of translating said balloon longitudinally to position saidstiffener at a second longitudinal orientation and to position saidradio-opaque portion at another position.
 56. The method of claim 55wherein said step of modifying the orientation further comprises thestep of determining said second longitudinal orientation with referenceto said radio-opaque portion.
 57. The method of claim 47 wherein saidlongitudinal stiffener is coextensive with a length of a cylindricalsection of the balloon.
 58. The method of claim 47 wherein saidlongitudinal stiffener is shorter than a length of a cylindrical sectionof the balloon.
 59. A method of configuring an expandable device locatedin an anatomical lumen comprising the steps of: introducing into saidanatomical lumen a balloon having a stiffener attached at a perimeter ofsaid balloon; orienting said stiffener with said expandable device; andexpanding said balloon to cause said stiffener to exert a first radialforce against said expandable device to configure said device.
 60. Themethod of claim 59 wherein said step of orienting comprises the step ofdetermining a first rotational orientation of said stiffener by viewinga radio-opaque portion of said stiffener located at a first position.61. The method of claim 60 wherein said step of orienting furthercomprises the step of rotating said balloon around a longitudinal axisof said balloon to position said stiffener at a second rotationalorientation and to position said radio-opaque portion at a secondposition.
 62. The method of claim 61 wherein said step of orientingfurther comprises the step of determining said second rotationalorientation by viewing said radio-opaque portion located at said secondposition.
 63. The method of claim 62 wherein said expandable device is astent.
 64. The method of claim 62 wherein said expandable device is astent-graft.
 65. The method of claim 59 wherein said step of expandingsaid balloon comprises the step of expanding said balloon to cause saidstiffener to expand said device.
 66. The method of claim 59 wherein saidstep of orienting comprises the step of determining a first longitudinalorientation of said stiffener by viewing a radio-opaque portion of saidstiffener located at a first position.
 67. The method of claim 66wherein said step of orienting further comprises the step of translatingsaid balloon longitudinally to position said stiffener at a secondlongitudinal orientation and to position said radio-opaque portion at asecond position.
 68. The method of claim 67 wherein said step oforienting further comprises the step of determining said secondlongitudinal orientation by viewing said radio-opaque portion located atsaid second position.
 69. A method of delivering an expandable device inan anatomical lumen comprising the steps of: introducing into saidanatomical lumen a balloon having a stiffener attached at a perimeter ofsaid balloon and carrying an expandable device; and expanding saidballoon to cause said stiffener to exert a first radial force againstsaid expandable device to expand said device.
 70. The method of claim 69further comprising the steps of: deflating said balloon to reduce saidfirst radial force; rotating said balloon around a longitudinal axis ofsaid balloon to orient said stiffener with a portion of said device thatis not completely expanded; and expanding said balloon to cause saidstiffener to exert a second radial force against said portion to expandsaid device.
 71. The method of claim 69 further comprising the steps of:determining a first rotational orientation of said stiffener by viewinga radio-opaque portion of said stiffener located at a first position;rotating said balloon around a longitudinal axis of said balloon toreposition said stiffener; determining a second rotational orientationof said stiffener by viewing said radio-opaque portion located at asecond position; and expanding said balloon to cause said stiffener toexert a second radial force against said device to further expand saiddevice.
 72. The method of claim 71 wherein said step of rotatingcomprises the step of deflating said balloon to reduce said first radialforce.
 73. The method of claim 69 further comprising the steps of:deflating said balloon to reduce said first radial force; translatingsaid balloon longitudinally to orient said stiffener with a portion ofsaid device that is not completely expanded; and expanding said balloonto cause said stiffener to exert a second radial force against saidportion to expand said device.
 74. The method of claim 69 furthercomprising the steps of: determining a first longitudinal orientation ofsaid stiffener by viewing a radio-opaque portion of said stiffenerlocated at a first position; translating said balloon longitudinally toreposition said stiffener; determining a second longitudinal orientationof said stiffener by viewing said radio-opaque portion located at asecond position; and expanding said balloon to cause said stiffener toexert a second radial force against said device to further expand saiddevice.
 75. The method of claim 74 wherein said step of translatingcomprises the step of deflating said balloon to reduce said first radialforce.
 76. A method of dilating an anatomical lumen comprising the stepsof: introducing into said anatomical lumen a balloon having a stiffenerattached at a perimeter of said balloon, wherein said stiffener includesa radio-opaque portion; determining an orientation of said stiffener byviewing said radio-opaque portion located at a first position; orientingsaid stiffener within said anatomical lumen; and expanding said balloonto cause said stiffener to exert a first radial force against saidanatomical lumen to dilate said anatomical lumen.
 77. The method ofclaim 76 wherein said step of determining further comprises the step ofdetermining a first rotational orientation of said stiffener by viewingsaid radio-opaque portion located at said first position.
 78. The methodof claim 77 wherein said step of orienting further comprises the step ofrotating said balloon around a longitudinal axis of said balloon toposition said stiffener at a second rotational orientation and toposition said radio-opaque portion at a second position.
 79. The methodof claim 78 wherein said step of orienting further comprises the step ofdetermining said second rotational orientation by viewing saidradio-opaque portion located at said second position.
 80. The method ofclaim 76 wherein said step of orienting further comprises the step ofdetermining a first longitudinal orientation of said stiffener byviewing said radio-opaque portion located at said first position. 81.The method of claim 80 wherein said step of orienting further comprisesthe step of translating said balloon longitudinally to position saidstiffener at a second longitudinal orientation and to position saidradio-opaque portion at a second position.
 82. The method of claim 81wherein said step of orienting further comprises the step of determiningsaid second longitudinal orientation by viewing said radio-opaqueportion located at said second position.
 83. A method of treating astenosis in an anatomical lumen comprising the steps of: introducinginto said anatomical lumen a balloon having a stiffener attached at aperimeter of said balloon, wherein said stiffener has a radio-opaqueportion and includes a projection; determining an orientation of saidprojection by viewing said radio-opaque portion located at a firstposition; orienting said projection with said stenosis; and expandingsaid balloon to cause said projection to exert a first radial forceagainst said stenosis.
 84. The method of claim 83 wherein said step ofdetermining further comprises the step of determining a first rotationalorientation of said projection by viewing said radio-opaque portionlocated at said first position.
 85. The method of claim 84 wherein saidstep of orienting further comprises the step of rotating said balloonaround a longitudinal axis of said balloon to position said projectionat a second rotational orientation and to position said radio-opaqueportion at a second position.
 86. The method of claim 85 wherein saidstep of orienting further comprises the step of determining said secondrotational orientation by viewing said radio-opaque portion located atsaid second position.
 87. The method of claim 83 wherein said step oforienting further comprises the step of determining a first longitudinalorientation of said projection by viewing said radio-opaque portionlocated at said first position.
 88. The method of claim 87 wherein saidstep of orienting further comprises the step of translating said balloonlongitudinally to position said projection at a second longitudinalorientation and to position said radio-opaque portion at a secondposition.
 89. The method of claim 88 wherein said step of orientingfurther comprises the step of determining said second longitudinalorientation by viewing said radio-opaque portion located at said secondposition.
 90. A stiffened balloon for use within an anatomic structure,said stiffened balloon comprising: an expandable balloon; and astiffening member attached at a perimeter of said balloon; wherein saidballoon is made of a flexible material; wherein said stiffening memberis less flexible than said balloon; wherein said stiffening memberaffects a configuration of an area of said perimeter; and wherein atleast a portion of said stiffening member is sufficiently radio-opaqueto permit a precise determination of an orientation of said balloonwithin an anatomical structure.
 91. The balloon of claim 90 wherein saidportion has a radio-opacity substantially equivalent to a radio-opacityof a marker band.
 92. The balloon of claim 90 wherein said portioncomprises an external surface of said stiffening member.
 93. The balloonof claim 90 wherein said portion comprises both ends of said stiffeningmember.
 94. The balloon of claim 90 wherein said portion comprises anend of said stiffening member.
 95. The balloon of claim 90 wherein saidportion comprises a central portion of said stiffening member.
 96. Theballoon of claim 90 wherein said portion comprises the entirety of saidstiffening member.
 97. The balloon of claim 90 wherein said stiffeningmember is coextensive with a length of a cylindrical section of saidballoon.
 98. The balloon of claim 90 wherein said stiffening member islongitudinally oriented with respect to said balloon and said stiffeningmember is shorter than a length of a cylindrical section of saidballoon.
 99. The balloon of claim 98 wherein said stiffening member islocated at a proximal end of said balloon.
 100. The balloon of claim 98wherein said stiffening member is located at a distal end of saidballoon.
 101. The balloon of claim 90 wherein said stiffening memberincludes a projection.
 102. The balloon of claim 101 wherein saidprojection is sufficiently radio-opaque to permit a precisedetermination of an orientation of said balloon within an anatomicalstructure.
 103. The balloon of claim 102 wherein said portion comprisessaid projection.
 104. The balloon of claim 103 wherein said projectionhas a radio-opacity substantially equivalent to a radio-opacity of amarker band.